Form 10 - Nebraska And City Sales And Use Tax Return

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Nebraska and City Sales and
FORM
Use Tax Return
10
• Read instructions on reverse side
PLEASE DO NOT WRITE IN THIS SPACE
Nebraska I.D. Number
City Code
Tax Period
NAME AND LOCATION ADDRESS
NAME AND MAILING ADDRESS
Check this box if this is your final return.
a Do you have an ownership change requiring a new state identification number? __________
b Has your business discontinued? __________
1 Gross sales and services (as reported on Nebraska Schedule III) .................................
1 $
00
2 Net taxable sales (as reported on Nebraska Schedule III) .............................................
2
00
3 Nebraska sales tax (line 2 multiplied by
) ..............................................
3
4 Nebraska consumer’s use tax (as reported on
Nebraska Schedule III)............................................................ 4
Complete Nebraska Schedule I prior to completing lines 5 & 6
5 City consumer’s use tax (line 113, Nebraska Schedule I) ......... 5
6 City sales tax (line 114, Nebraska Schedule I) ..............................................................
6
7 Total Nebraska and city sales tax (line 3 plus line 6)......................................................
7
8 Sales tax collection fee (line 7 multiplied by
of first $
and by
on excess over $
) .....................................
8
9 Sales tax due (line 7 minus line 8) .................................................................................
9
10 Total Nebraska and city consumer’s use tax (line 4 plus line 5) ..................................... 10
11 Total Nebraska and city sales and use tax due (line 9 plus line 10) ................................ 11
12 Previous balance with applicable interest at
% per year and payments received through
12
Check this box if your payment is being made by Electronic Funds Transfer (EFT).
13 BALANCE DUE (line 11 plus or minus line 12). Pay in full with return ............................ 13 $
Under penalties of law, I declare that as taxpayer or preparer I have examined this return, including accompanying schedules and
statements, and to the best of my knowledge and belief, it is correct and complete.
sign
(
)
(
)
here
Authorized Signature
Daytime Phone
Signature of Preparer Other Than Taxpayer
Daytime Phone
Title
Date
Address
Date
TELEFILERS — DO NOT SEND IN A PAPER RETURN.
THIS RETURN IS DUE ON OR BEFORE THE TWENTY-FIFTH DAY OF THE MONTH FOLLOWING THE TAX PERIOD INDICATED ABOVE
Mail this return and payment to: NEBRASKA DEPARTMENT OF REVENUE, P.O. BOX 94818, LINCOLN, NE 68509-4818

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